Srinagar, Indian-administered Kashmir – Afiya’s* frail fingers pick at the loose threads of her worn dark-brown sweater. She sits at the edge of her bed in the rehabilitation ward of Shri Maharaja Hari Singh (SMHS) Hospital in Indian-administered Kashmir’s main city of Srinagar.

As the faded and stained clothes hang loosely on her thin frame, and with down-cast eyes, she says: “I used to dream of flying high above the mountains, touching the blue sky as a flight attendant. Now, I am stuck in a nightmare, high on drugs, fighting for my life.”

Recommended Stories

list of 4 itemsend of list

Afiya, 24, is only one among thousands of people addicted to heroin in the disputed region where a growing epidemic of drug addiction is consuming young lives.

A 2022 study by the psychiatry department of the Government Medical College in Srinagar found that Kashmir had overtaken Punjab, the northwestern Indian state battling a drug crisis for decades, in the number of cases of narcotics use per capita.

In August 2023, an Indian Parliament report estimated that nearly 1.35 million of Kashmir’s 12 million people were drug users, suggesting a sharp rise from the nearly 350,000 such users in the previous year as estimated in a survey by the Institute of Mental Health and Neurosciences (IMHANS) at the Government Medical College, Srinagar.

Advertisement

The IMHANS survey also found that 90 percent of drug users in Kashmir were aged between 17 and 33.

SMHS, the hospital Afiya is in, attended to more than 41,000 drug-related patients in 2023 – an average of one person brought in every 12 minutes, a 75 percent increase from the figure in 2021.

The surge in Kashmir’s drug cases was mainly fuelled by its proximity to the so-called “Golden Crescent”, a region covering parts of neighbouring Pakistan, Afghanistan and Iran, where opium is grown on a large scale. Experts also say chronic unemployment – triggered by the region losing its partial autonomy in 2019, quickly followed by the COVID-19 pandemic – fuelled stress and despair, driving Kashmiri youth towards substance abuse.

As a result, says Dr Yasir Rather, a professor in charge of psychiatry at IMHANS, hospitals and treatment centres in the region are stretched. He said while addiction treatment facilities have been established across Kashmir since 2021, only a handful of hospitals have inpatient facilities for severe addiction patients like Afiya, who often require hospitalisation.

‘It seemed harmless’

“You will get through this,” Afiya’s mother, Rabiya*, whispers to her daughter, brushing aside the damp hair from Aafiya’s face. She has just had a bath. Afiya’s father, Tabish*, sits on a chair in a corner, silently watching them.

Afiya barely listens to her mother’s reassuring words and seems more focused on repeatedly removing the blue blanket provided by the hospital to let some fresh air caress the deep, black wounds on her hands, legs and stomach, caused by the needle pricks in her veins from injecting heroin. The gaping wounds now ooze blood and a thick, yellow pus, as doctors warn she could infect her parents and attendants.

More than six years ago, Afiya was a bright high-school student dreaming of becoming a flight attendant. After passing her 12th grade with impressive 85 percent marks, she responded to a job advertisement posted by a leading private Indian airline.

Advertisement

“This isn’t the real me lying in this bed,” Afiya tells Al Jazeera. “I used to drive my car. I was a stylish woman known for my beautiful handwriting, intellect and strong communication skills. My quick memory made me stand out. I could recall details effortlessly, never missing a thing. I was independent and confident.

“But now, I lie here motionless, like a dead fish, as my siblings put it. Even they can’t ignore the smell that lingers around me.”

She says she was selected for the airline job and sent to New Delhi for training. “I stayed there for two months. It felt like a new beginning, a chance to fly, to escape.”

But her soaring dreams were dashed to the ground in August 2019 when the Indian government scrapped the special status of Kashmir and imposed a months-long security lockdown to discourage street protests against the shock move.

Thousands of people, including top politicians, were arrested and thrown in jail. Internet and other basic rights were also suspended, as New Delhi brought the region under its direct control for the first time in decades.

“The situation back home was grim. There was no communication with my family, no phones, no way to know if they were safe. I couldn’t stay in New Delhi any more, disconnected like that. I took a week’s leave and went home,” Afiya said.

As she left the capital with help from other Kashmiris, little did she know her journey as a flight attendant had ended even before it began.

“By the time the situation [in Kashmir] improved, roads opened up, and I could think of going back to New Delhi, five months had passed. In that period, I lost my dream job, and with it, I lost myself,” she says as her eyes well up.

Advertisement

“I applied for jobs in other airlines but nothing worked out. With every rejection, I started losing hope. Then COVID hit and jobs became even scarcer. Over time, I lost interest in working altogether – my mind just wasn’t in it any more. I didn’t feel like doing anything.”

Afiya says that with each passing month, her frustration turned into despair. She began to spend more time with her friends, seeking solace in their company.

“At first, we just talked about our struggles,” she says. “Then it started with small temptations, with little puffs of cannabis to deal with the tension. It seemed harmless. Then someone offered me a foil [of heroin]. I didn’t think twice. It felt euphoric.”

“The only thing that gave me peace was drugs – everything else felt like it was burning me from inside.”

‘Ruthless hunger’

But the escape was short-lived, she says, and the cycle of dependence took over.

“The dream quickly turned into a nightmare. The euphoria faded and was replaced by a ruthless hunger,” she says as she describes the desperate measures and risks she began to take to find drugs.

“Once, I travelled 40km (25 miles) from Srinagar to south Kashmir’s Shopian district to meet a drug dealer. My friends were running out of stock and someone gave me his number. I called him directly to arrange the supply. He was a big dealer, and at that time, the only way to get what we needed.

“When I reached there, he introduced me to something called ‘tichu’ [local slang for injection]. He was the first person to introduce me to injecting drugs. He injected it into my belly right there in the car,” she says. “The rush was intense – it felt like heaven, but only for a moment.”

Advertisement

That moment of euphoria marked the beginning of her quick descent into deeper addiction.

“Heroin’s grip is merciless. It’s not just a drug, it becomes your life,” says Afiya. “I would stay up all night, coordinating with friends to make sure we had enough for the next day. It was exhausting, but the craving was stronger than all other kinds of pain.”

Heroin is the region’s most commonly used drug, with addicts spending thousands of rupees every month to buy it.

“Heroin has spread far and wide, and we are seeing a disturbingly high number of patients affected by it,” says IMHANS’s Rather.

The professor says he has noted a rise in substance abuse among women, attributing it to mental health struggles and unemployment.

“Before 2016, we rarely saw cases involving heroin. Most people used cannabis or other soft drugs. But heroin spreads like a virus, reaching everyone – men, women, even pregnant women,” he tells Al Jazeera. “Now, we see 300 to 400 patients daily, both new cases and follow-ups, and most involve heroin addiction.”

But why heroin?

“Because of its rapid and intense euphoric effects”, says Rather, “which many found more immediate and pleasurable compared to morphine”.

“It is easy to use, has higher potency, and the misconception that it was safer or more refined than other drugs only added to its appeal, despite its highly addictive nature.”

Advertisement

‘Wired to seek one last shot’

For addicts like Afiya, who has been admitted to rehab five times so far, the fight against heroin is a daily and uphill battle.

“Every time I leave the hospital, my body pulls me back to the streets,” she says. “It’s like my brain is wired to seek one last shot.”

Afiya’s intentions to recover remain uncertain. She has frequently left the hospital during rehab to seek heroin, or asked other patients for it during her daily walk at the hospital.

“Drug addicts have a way of connecting with each other,” Rabiya, her mother, tells Al Jazeera. “I once saw her talking to a male patient in English and I realised she was asking him for drugs.”

Rabiya says she once found drugs hidden behind the flush in a women’s toilet. “I found the stash and flushed it, but she [Afiya] still managed to get it [heroin] again,” she says. “She knows how to manipulate the system to get what she wants.”

A nurse at the SHMS rehab revealed how patients often bribed the security guards. “They give them money or come up with excuses to leave, even while on medication,” says the nurse, requesting anonymity as she is not allowed to talk to the media. The female ward is near the hospital’s entrance – that too makes it easier for patients to slip out unnoticed, she says.

“It’s heartbreaking because we try to help, but some patients just find ways to leave.”

“She [Afiya] escaped one night and came back the next day, having spent hours with male patients who helped her get heroin,” says a security guard, who also did not wish to disclose his identity for fear of losing his job.

Advertisement

But Afiya remains defiant. “These medicines don’t bring the peace I get from a single shot of heroin,” she tells Al Jazeera, her hands trembling and her nails digging into the hospital bed.

The physical toll on her body due to addiction has been severe. Open wounds on her legs, arms and belly ooze blood. When Dr Mukhtar A Thakur, a plastic surgeon at SMHS, first examined her, he says he was shocked.

“She was unable to walk because of a deep wound on her private parts and a large scar on her thigh. She had serious health problems, including damaged veins and infected wounds. Her liver, kidneys and heart were also affected. She struggled with memory loss, anxiety and painful withdrawal symptoms, leaving her in a critical condition,” he says.

Afiya’s parents say bringing her to the rehab at SMHS was a desperate move. “To protect her and the family’s reputation, we told our relatives she was being treated for stomach issues and scars from an accident,” says Rabiya.

“No one marries a drug addict here,” she adds. “Our neighbours and relatives already have doubts. They notice her scars, her unstable appearance and the repeated hospital visits.”

Afiya’s father says he often hides his face in public, “unable to bear the shame”.

Health experts say seeking treatment for drug addiction remains a challenge for Kashmiri women as social stigma and cultural taboos keep many women in the shadows.

“Rehabilitation for women is often done secretly because families don’t want anyone to know, and in Kashmir, everybody knows everybody,” Dr Zoya Mir, a clinical psychologist who runs a clinic in Srinagar, tells Al Jazeera.

Advertisement

“Many wealthy families send their daughters to other states for treatment, while others either suffer in silence or delay treatment until it’s too late,” she says. “These women need compassion, not judgement. Only then can they begin to heal.”

*Names have been changed to protect identities.